Vol 72, No 4 (2021)
Original paper
Published online: 2021-04-08

open access

Page views 1421
Article views/downloads 777
Get Citation

Connect on Social Media

Connect on Social Media

Parathyroid hormone serum concentration kinetic profile in critically ill patients undergoing continuous renal replacement therapies: a prospective observational study

Aneta Czarnik1, Ryszard Gawda2, Maciej Piwoda2, Maciej Marszalski2, Maciej Molsa3, Marek Pietka3, Marek Bolanowski4, Tomasz Czarnik2
Pubmed: 34010434
Endokrynol Pol 2021;72(4):329-335.


Introduction: Elevated serum parathormone (PTH) levels have been observed in acute kidney injury and are related to calcium-phosphate metabolism disturbance, decreased renal production of 1,25 dihydroxyvitamin D3, impaired renal PTH excretion, and other renal-independent factors. There are no data regarding PTH concentration kinetics in critically ill patients undergoing continuous renal replacement therapies (CRRT) in an intensive care setting. The primary objective of this study was to investigate trends in PTH serum levels in critically ill patients with multiorgan failure undergoing CRRT, by performing periodic PTH measurements in the acute phase of critical illness.

Material and methods: This was a single-centre, prospective, observational study conducted in an mixed, university-affiliated intensive care unit. Critically ill patients who fulfilled all of the following criteria were included: respiratory failure; circulatory failure; acute kidney injury treated by CRRT; and sequential organ failure assessment score (SOFA score) of 5 or more. Patients who met any of the following criteria were excluded: acute liver failure; hypercalcemia at admission (total calcium serum level > 10.6 mg/dL; total ionized calcium plasma level > 1.35 mmol/L); parathyroid gland disease; end-stage renal disease; patients undergoing therapeutic plasma exchange or extracorporeal membrane oxygenation procedures; aged under 18 years;  pregnant; and life expectancy after admission to the intensive care unit anticipated to be less than 72 hours as assessed by the investigator.

Results: Thirty patients met the inclusion criteria. A statistically significant change in PTH over time was observed (Friedman ANOVA; p = 0.0001). The post-hoc test showed a statistically significant decrease in PTH: measurements 5–8 relative to measurement 1, and measurements 4–8 relative to measurement 2 (p < 0.05). No significant correlations between 25 hydroxyvitamin D3 deficiency, age, diagnosis, SOFA score, and PTH levels were observed. A statistical test indicated that serum concentrations of PTH were significantly higher in the de novo sepsis group (p < 0.05).

Conclusions: The PTH serum concentration decreases during the course of CRRT in the majority of patients. When the course of the disease starts to be complicated by sepsis, PTH serum levels then remain high. A probable reason for this is the existence of the inflammatory state triggered by sepsis.

Article available in PDF format

View PDF Download PDF file


  1. Goltzman D. Physiology of Parathyroid Hormone. Endocrinol Metab Clin North Am. 2018; 47(4): 743–758.
  2. Goltzman D, Mannstadt M, Marcocci C. Physiology of the Calcium-Parathyroid Hormone-Vitamin D Axis. Front Horm Res. 2018; 50: 1–13.
  3. Lind L, Carlstedt F, Rastad J, et al. Hypocalcemia and parathyroid hormone secretion in critically ill patients. Crit Care Med. 2000; 28(1): 93–99.
  4. Carlstedt F, Lind L, Wide L, et al. Serum levels of parathyroid hormone are related to the mortality and severity of illness in patients in the emergency department. Eur J Clin Invest. 1997; 27(12): 977–981.
  5. Burchard KW, Gann DS, Colliton J, et al. Ionized calcium, parathormone, and mortality in critically ill surgical patients. Ann Surg. 1990; 212(4): 543–9; discussion 549.
  6. Fligor SC, Love KM, Collier BR, et al. Parathyroid hormone as a marker for hypoperfusion in trauma: A prospective observational study. J Trauma Acute Care Surg. 2017; 83(6): 1142–1147.
  7. Nair P, Lee P, Reynolds C, et al. Significant perturbation of vitamin D-parathyroid-calcium axis and adverse clinical outcomes in critically ill patients. Intensive Care Med. 2013; 39(2): 267–274.
  8. Czarnik T, Czarnik A, Gawda R, et al. Vitamin D kinetics in the acute phase of critical illness: A prospective observational study. J Crit Care. 2018; 43: 294–299.
  9. Hu J, Luo Z, Zhao X, et al. Changes in the calcium-parathyroid hormone-vitamin d axis and prognosis for critically ill patients: a prospective observational study. PLoS One. 2013; 8(9): e75441.
  10. Pietrek J, Kokot F, Kuska J. Serum 25-hydroxyvitamin D and parathyroid hormone in patients with acute renal failure. Kidney Int. 1978; 13(2): 178–185.
  11. Kokot F, Mleczko Z, Pazera A. Parathyroid hormone, prolactin, and function of the pituitary-gonadal axis in male patients with acute renal failure. Kidney Int. 1982; 21(1): 84–89.
  12. Fuss M, Bagon J, Dupont E, et al. Parathyroid Hormone and Calcium Blood Levels in Acute Renal Failure. Nephron. 2008; 20(4): 196–202.
  13. Tandukar S, Palevsky PM. Continuous Renal Replacement Therapy: Who, When, Why, and How. Chest. 2019; 155(3): 626–638.
  14. De Francisco AL, Amado JA, Prieto M, et al. Dialysis membranes and PTH changes during hemodialysis in patients with secondary hyperparathyroidism. Nephron. 1994; 66(4): 442–446.
  15. Šafránek R, Moučka P, Vávrová J, et al. Changes of serum calcium, magnesium and parathyroid hormone induced by hemodialysis with citrate-enriched dialysis solution. Kidney Blood Press Res. 2015; 40(1): 13–21.
  16. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int. 2012; 2012(Suppl): 1–138.
  17. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017; 45(3): 486–552.
  18. Honore PM, Mugisha A, Kugener L, et al. Who may benefit most from future vitamin D intervention trials: do not forget patients on continuous renal replacement therapy. Crit Care. 2020; 24(1): 180.
  19. Greulich T, Regner W, Branscheidt M, et al. Altered blood levels of vitamin D, cathelicidin and parathyroid hormone in patients with sepsis-a pilot study. Anaesth Intensive Care. 2017; 45(1): 36–45.
  20. Czarnik T, Czarnik A, Gawda R, et al. Vitamin D serum levels in multiorgan failure critically ill patients undergoing continuous renal replacement therapies. Anaesthesiol Intensive Ther. 2020; 52(5): 359–365.
  21. Carlstedt F, Lind L, Rastad J, et al. Parathyroid hormone and ionized calcium levels are related to the severity of illness and survival in critically ill patients. Eur J Clin Invest. 1998; 28(11): 898–903.
  22. Yang T, Wang W, Tang X, et al. Association between mineral and bone disorder in patients with acute kidney injury following cardiac surgery and adverse outcomes. BMC Nephrol. 2019; 20(1): 369.
  23. Ardehali SH, Dehghan S, Baghestani AR, et al. Association of admission serum levels of vitamin D, calcium, Phosphate, magnesium and parathormone with clinical outcomes in neurosurgical ICU patients. Sci Rep. 2018; 8(1): 2965.
  24. Cheng SP, Liu CL, Liu TP, et al. Association between parathyroid hormone levels and inflammatory markers among US adults. Mediators Inflamm. 2014; 2014: 709024.
  25. Mitnick MA, Grey A, Masiukiewicz U, et al. Parathyroid hormone induces hepatic production of bioactive interleukin-6 and its soluble receptor. Am J Physiol Endocrinol Metab. 2001; 280(3): E405–E412.